Current role of computed tomography-guided transthoracic needle biopsy of metastatic lung lesions

AIM: As part of the Catania symposium on lung metastasectomy we reviewed our practice of computed tomography (CT)-guided percutaneous transthoracic needle biopsy of pulmonary metastatic lesions with particular emphasis on diagnostic accuracy and nature of complications lesions. MATERIALS & METHODS: 25 patients with metastatic lesions of the lung have been evaluated between May 2010 and February 2014. Inclusion criteria consisted of patients with histologically confirmed, metastatic disease of the lung, those receiving a CT-guided needle biopsy, were at least 18 years of age; and with adequate hepatic, renal and hematological function. We recorded also the size of the sampled lesions, their distance from the pleura, the complications encountered (pneumothorax and thoracostomy tube placement), the cytological diagnosis and the outcome in all the cases. RESULTS: CT-guided percutaneous transthoracic needle biopsy were performed on 23 of 25 patients with suspected lung metastases. 17 males and six females with a mean age of 71.4 years. The mean size of lesions was 4.2 cm (range: 1 to 17 cm). For CT-guided needle biopsy, an 18 gauge semi-automatic needle biopsy device was used. Of 23 biopsies, 20 (87%) yielded a correct diagnosis with specific histological typing for metastasis. Pneumothorax was the most common complication occurring in four cases (5.7%). CONCLUSION: CT-guided percutaneous transthoracic needle biopsy is a firm, useful and safe technique for the diagnosis of suspected pulmonary metastases as it avoids open biopsy in most cases

Peritumoral perfusion and proton spectroscopic MR imaging in the differentiation of gliomas and solitary metastases

Purpose: To asses the value of peritumoural perfusion-weighted and proton spectroscopic MR imaging in preoperative grading of gliomas and in differentiating between primary gliomas and solitary metastases. Methods and Materials: Ten low-grade gliomas, eight high-grade gliomas, and ten metastases were prospectively evaluated with MR imaging, dynamic susceptibility contrast-enhanced perfusion imaging, and single-voxel proton MR spectroscopy before surgical resection or stereotactic biopsy. Maximal rCBV values and maximal Cho/Cr ratios were calculated from peritumoural region surrounding the tumour. Tumour grade presumed with these values was compared to histopathologic grading. Differences in the study parameters between groups were assessed using the Mann-Whitney test. A Receiver Operating Characteristic analysis was performed to determine cutoff values. Results: A clear rCBV cutoff value of 1.88 was detected for differentiating low-grade gliomas from high-grade gliomas (sensitivity 100%, specificity 90%, area under the ROC curve .994, p< 0.0001). A clear rCBV cutoff value of 1.20 was detected for differentiation of metastases from gliomas (sensitivity 100%, specificity 90%, area under the ROC curve .972, p< 0.0001). The differences in the Cho/Cr ratios in the peritumoural regions of high-grade gliomas and of solitary metastasis were statistically significant (p<.001) but a clear cutoff value was not found. Conclusion: Our preliminary data support that peritumoural perfusion-weighted imaging can assist in preoperative differentiation between a glioma and a solitary metastasis, along with separating high-grade gliomas from low-grade gliomas

A rare case of Enchondromatosis of the knees and hands with involvement of Hoffa's fat pad and peri-articular soft-tissues

We report a case of a 56-year old man with chronic pain in both knees for several years. This patient had already undergone surgery on his left knee in 2002 after an x-ray showed multiple lytic and well margined lesions in the distal femur and proximal tibia with ground-glass matrix, involving Hoffa's fat pad and the patellar ligament. Histology was consistent with an enchondroma. The most recent MRI examination showed enchondromatosis involving both knees with bilateral extension into Hoffa's fat pad and the patellar ligament. Subsequently, we performed an additional radiographic examination of the hands and feet, as well as an MRI of both hands to identify other possible enchondromas in the most common sites for this disease. Enchondromatosis with soft tissue involvement is extremely rare, and involvement of Hoffa's fat pad has not been reported in the scientific literature. The clinical presentation of this case and the general aspects of Enchondromatosis are discussed

Evolution of indeterminate hepatocellular nodules at Gd-EOB-DPTA-enhanced MRI in cirrhotic patients

To retrospectively analyze the evolution of indeterminate hepatocellular nodules in cirrhotic patients on serial Gd-EOB-DPTA-enhanced MRI, and to identify predictors of HCC development

Evaluation of lumbar pain with weight-bearing MRI: Preliminary experience.

PURPOSE/INTRODUCTION: To assess the usefulness of weight-bearing examination of the lumbar spine performed with a dedicated MRI scanner in the evaluation of patients with clinical evidence of lumbar pain. MATERIALS AND METHODS: Between August 2008 and July 2009, 40 patients with clinical evidence of lumbar pain (group A) and a similar number of healthy volunteers (group B) were submitted to MRI examination of lumbar spine. Spin echo T1w and fast spin echo T2w images were acquired with a 0.25 Tesla scanner (G-Scan, Esaote Spa, Genoa, Italy) in both weight-bearing position and conventional supine position. A dedicated receiving coil for the lumbar spine was used. Three radiologists, blinded on history and clinical examination of subjects, assessed, in consensus, variations of lumbar lordosis angle and presence of pathology on images acquired in both positions, in different sequences and in different planes. RESULTS: In group A, conventional supine MRI was positive for pathology in 30/40 cases while weight-bearing MRI was positive in 39/40 cases. In all cases of group B, no signs of pathology was found in both positions. Weight-bearing MRI showed modifications of lumbar lordosis angle in all cases of both groups in respect to conventional supine MRI. DISCUSSION/CONCLUSION: Imaging the lumbar spine in weight-bearing position with a dedicated MRI scanner and a dedicated coil could allow identification of pathology which could be overlooked if imaging patients only in the supine position

Multiple sclerosis: High prevalence of the ‘central vein’ sign in white matter lesions on susceptibility-weighted images

Purpose: The aim of this study was to determine the occurrence and distribution of the ‘central vein’ sign in white matter lesions on susceptibility-weighted magnetic resonance images in patients with multiple sclerosis (MS) and cerebral small vessel disease (CSVD). Materials and methods: T2-weighted and fluid-attenuated inversion recovery magnetic resonance images of 19 MS patients and 19 patients affected by CSVD were analysed for the presence and localisation of focal hyperintense white matter lesions. Lesions were subdivided into periventricular or non-periventricular (juxtacortical, subcortical, deep white matter and cerebellar) distributed. The number and localisation of lesions presenting with the central vein sign were recorded and compared between MS and CSVD lesions. Results: A total of 313 MS patients and 75 CSVD lesions were identified on T2-weighted and fluid-attenuated inversion recovery magnetic resonance images. The central vein sign was found in 128 MS lesions (40.9%), and the majority of them (71/128, 55.5%) had a periventricular distribution. The central vein sign was found in 22 out of 75 (29.3%) CSVD lesions, and periventricular distribution was seen in six out of 22 (27.2%) CSVD lesions. The difference in the proportion of white matter hyperintense lesions that presented with the central vein sign on susceptibility-weighted images in patients with MS and CSVD was statistically different, and a significantly higher number of MS patients presented with lesions with the central vein sign compared to CSVD patients. Conclusion: The presence of the central vein sign on susceptibility-weighted images for MS lesions improves the understanding of the periventricular distribution of MS lesions and could contribute as adjunctive diagnostic criteria for MS disease

Splenic hemangiomas: contrast-enhanced sonographic findings

Objectives-The purpose of this study was to illustrate the baseline appearance and enhancement patterns of splenic hemangiomas on contrast-enhanced sonography. Methods-Two experienced radiologists retrospectively reviewed by consensus baseline and contrast-enhanced sonographic examinations of 27 patients (14 women and 13 men; mean age, 58.7 years) with 27 splenic hemangiomas (mean size, 2 cm) confirmed by splenectomy, biopsy, computed tomography, and magnetic resonance imaging and follow-up. Results-On baseline sonography, 77.8% of the lesions showed a homogeneous echo texture that was mainly hyperechoic. Color Doppler imaging did not show any signal in 81.5% of the cases. After contrast agent injection, 59.2% of the splenic hemangiomas showed different degrees of contrast enhancement in the arterial phase followed by isoenhancement in the late parenchymal phase. Among these, 2 hemangiomas showed peripheral globular enhancement in the arterial phase, followed by progressive centripetal fill-in. In 29.6% of the cases, some degree of contrast enhancement was appreciable, but the hemangiomas remained substantially hypoechoic throughout the contrast-enhanced sonographic examinations, whereas in 11.1%, the combination of contrast enhancement in the arterial phase followed by wash-out in the late parenchymal phase was evident. Conclusions-Isoechogenicity to spleen parenchyma in all phases is the most frequent typical enhancement pattern of splenic hemangiomas observed on contrast-enhanced sonography. Nevertheless, these lesions may show atypical contrast enhancement patterns; therefore, further assessment with cross-sectional techniques is needed

Focal nodular hyperplasia: a weight-based, intraindividual comparison of gadobenate dimeglumine and gadoxetate disodium-enhanced MRI

PURPOSE: We aimed to qualitatively and quantitatively compare the enhancement pattern of focal nodular hyperplasia after gadobenate dimeglumine and gadoxetate disodium injection in the same patient. METHODS: 1.5 T magnetic resonance imaging (MRI) examinations of 16 patients with 21 focal nodular hyperplasias studied after the injection of both contrast media were evaluated. Both MRI studies were performed in all patients. A qualitative analysis was performed evaluating each lesion in all phases. For quantitative analysis we calculated signal intensity ratio, lesion-to-liver contrast ratio and liver parenchyma signal intensity gain on hepatobiliary phase. Statistical analysis was performed with the Wilcoxon sign-rank test for clustered paired data and the McNemar test for paired frequencies. A P value < 0.05 was considered statistically significant. RESULTS: At qualitative analysis no statistically significant differences were evident during any of the contrast-enhanced phases. Signal intensity ratio (P = 0.048), lesion-to-liver contrast ratio (P = 0.032) and liver parenchyma signal intensity gain (P = 0.012) were significantly higher on hepatobiliary phase after gadoxetate disodium injection. CONCLUSION: There were no significant differences in the MRI findings of focal nodular hyperplasia after the injection of a weight-based dose of either gadobenate dimeglumine or gadoxetate disodium

Imaging appearance of treated hepatocellular carcinoma.

Surgical resection and imaging guided treatments play a crucial role in the management of hepatocellular carcinoma (HCC). Although the primary end point of treatment of HCC is survival, radiological response could be a surrogate end point of survival, and has a key role in HCC decision-making process. However, radiological assessment of HCC treatment efficacy is often controversial. There are few doubts on the evaluation of surgical resection; in fact, all known tumor sites should be removed. However, an unenhancing partial linear peripheral halo, in most cases, surrounding a fluid collection reducing in size during follow-up is demonstrated in successfully resected tumor with bipolar radiofrequency electrosurgical device. Efficacy assessment of locoregional therapies is more controversial and differs between percutaneous ablation (e.g., radiofrequency ablation and percutaneous ethanol injection) and transarterial treatments (e.g., conventional transarterial chemoembolization, transarterial chemoembolization with drug eluting beads and radioembolization). Finally, a different approach should be used for new systemic agent that, though not reducing tumor mass, could have a benefit on survival by delaying tumor progression and death. The purpose of this brief article is to review HCC imaging appearance after treatment